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GLP-1 Drugs for Obesity: Insurance, Side Effects, and Other Questions Answered

Written and medically reviewed by Kelsey Stalvey, Pharm.D.
Posted on September 12, 2024

Semaglutide, sold under the brand names Ozempic and Wegovy, has become a buzzword in the world of weight loss. Originally designed to treat type 2 diabetes, these injectable medications and those like it have proven effective for helping some people shed pounds. As interest in weight loss treatments grows, many people are turning to semaglutide and similar drugs.

If you’re considering semaglutide for weight loss, you probably have questions about how it works, what side effects to expect, and whether your insurance will cover it. Let’s explore everything you need to know about using semaglutide to treat obesity.

What Is Semaglutide and How Does It Work?

Semaglutide is a medication that mimics a hormone in the body called glucagon-like peptide 1 (GLP-1). This hormone helps regulate blood glucose (blood sugar) and appetite, playing a crucial role in weight management.

Semaglutide can help with:

  • Appetite suppression — Semaglutide activates GLP-1 receptors in the brain, reducing hunger. This makes it easier to eat less and lose weight.
  • Slower digestion — It slows down how quickly food leaves the stomach, which helps you feel full longer.
  • Blood sugar control — Originally used for diabetes treatment, semaglutide also helps control blood sugar, which is beneficial for those at risk of type 2 diabetes.

Ozempic is the semaglutide formulation prescribed to treat type 2 diabetes. Semaglutide is also available under the brand name Wegovy, which the U.S. Food and Drug Administration (FDA) specifically approved for weight loss. While both drugs contain the same active ingredient, Wegovy is prescribed at a higher dose to maximize its weight loss effects.

How Effective Is Semaglutide for Weight Loss?

An early clinical trial studied nearly 2,000 people with a body mass index (BMI) score in the obese range. The study participants took semaglutide or a placebo (inactive treatment) in combination with a diet and exercise plan. Half of the participants who took semaglutide lost an average of 14.9 percent of their initial body weight over 68 weeks. Around 70 percent of participants lost at least 10 percent of their body weight. Participants in the placebo group lost, on average, about 2.4 percent of their body weight.

However, results varied. In the above study, 7 percent of participants did not finish the trial due to side effects from the medication, and some people did not lose weight.

Factors like diet, exercise, and how your body responds to the medication will influence your experience. While some people may lose more weight, others might progress more slowly or find they cannot tolerate the medicine.

Common Side Effects of Semaglutide

As with most medications, semaglutide has potential side effects. Most are mild and improve as your body adjusts, but knowing what to expect can help you manage them better.

  • Nausea — This is the most frequently reported side effect, especially during the first few weeks of treatment. It typically decreases as your body adjusts.
  • Diarrhea — Some users experience diarrhea, which can be managed by staying hydrated and adjusting your diet.
  • Vomiting — Though less common, vomiting can occur, particularly if the dose increases too quickly.
  • Constipation — Some patients report constipation, especially in the early stages. Increasing fiber intake can help.
  • Fatigue — Feeling excessively tired is another possible side effect. It’s usually temporary as your body adapts to the treatment.

If side effects persist or become severe, it’s crucial to talk to your doctor. Adjusting the dosage or using additional medication can help manage these symptoms.

Long-Term Side Effects and Risks

While semaglutide is generally safe, users should be aware of some potential long-term risks.

  • Thyroid tumors — Animal studies have shown a risk of thyroid tumors, including cancer. Although this hasn’t been confirmed in humans, the FDA advises against using semaglutide if you have a history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2.
  • Pancreatitis — Inflammation of the pancreas is a rare but serious risk. Symptoms include severe abdominal pain, nausea, and vomiting. Seek medical attention immediately if these occur.
  • Gallbladder issues — Rapid weight loss can sometimes lead to gallstones or other gallbladder problems.
  • Nutrient deficiency — Significant weight loss might also result in deficiencies in essential vitamins and minerals. Regular monitoring and possibly supplementation can help mitigate this risk.

How Long Should You Stay on Semaglutide?

The duration of treatment with semaglutide for weight loss varies based on your goals and how well the medication works for you. Many continue using semaglutide as long as they are seeing positive results and are not experiencing side effects.

If you stop taking semaglutide, there’s a likelihood of gaining weight. The medication’s appetite-suppressing effects will no longer be in play, so it’s important to work with your health care team on a plan for maintaining your weight loss through diet and exercise.

Your doctor will help determine the best duration for your treatment, which may involve ongoing use or gradual tapering off as you meet your weight loss goals.

Safety and Proper Dosing: What You Need To Know

Proper dosing is critical when using semaglutide. The medication typically starts at a lower dose to minimize side effects and is gradually increased.

  • Starting dose — Usually, people begin with a low dose to allow their body to adjust.
  • Dosage increases — Over time, the dose is gradually increased to maximize effectiveness while minimizing side effects.
  • Compounded versions — The FDA has issued a warning about dosing errors when using compounded versions of semaglutide. These are custom-made formulations prepared by pharmacies, often when the commercial drug is unavailable. If you choose to try a compounded formula of semaglutide, it’s essential to obtain it from a reputable sources and follow dosing instructions closely to avoid serious complications.

Does Insurance Cover Wegovy or Ozempic for Obesity?

Insurance coverage for Ozempic and Wegovy can be challenging. Since Ozempic is primarily approved for treating type 2 diabetes, insurance companies are more likely to cover it for that purpose. Coverage for weight loss, particularly for Wegovy, which is approved for obesity management, varies widely. The manufacturer of Ozempic, Novo Nordisk, offers a savings card, which can help some people save money if they are qualified.

Tips To Improve Your Chances of Coverage

  • Review your insurance plan — Some insurance plans may cover Ozempic or Wegovy for weight loss if you meet specific criteria, such as having a high BMI score or related health conditions.
  • Consult your doctor — It may help to have a strong recommendation from your health care provider indicating that weight loss is medically necessary for you.
  • Appeal a denial — If your insurance denies coverage, you can appeal the decision. Provide additional documentation from your doctor, and explain the medical necessity of the medication.

Talking With Your Doctor About Semaglutide

Semaglutide can aid in weight loss, helping people reach and maintain a healthier weight. However, it’s important to consider the potential side effects, proper dosing, and the challenges of obtaining insurance coverage.

Before beginning any treatment, it’s essential to have a thorough discussion with your health care provider. They can help you determine if semaglutide is the right option for you, guide you through the insurance process, and monitor your progress to ensure the medication is working safely and effectively.

Talk With Others Who Understand

MyObesityTeam is the social network for people with obesity and their loved ones. On MyObesityTeam, more than 53,000 members come together to ask questions, give advice, and share their stories with others who understand life with obesity.

Are you thinking of taking semaglutide? If you’ve already tried it, what has your experience been like? Share your experience in the comments below, or start a conversation by posting on your Activities page.

Kelsey Stalvey, Pharm.D. received her Doctor of Pharmacy from Pacific University School of Pharmacy in Portland, Oregon, and went on to complete a one-year postgraduate residency at Sarasota Memorial Hospital in Sarasota, Florida. Learn more about her here.

A MyObesityTeam Member

I was given Ozempic for type ll diabetes. I had a gallbladder attack and they didn't remove it because of my weight and my A1c. I need help to get rid of the weight the mental health meds have given… read more

October 15
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